The Importance of Positive Affect in Treatment of Depression – Prof Koen Demyttenaere
Prof Koen Demyttenaere, M.D., PhD serves as the Chair of the Department of Psychiatry in the University Psychiatric Center KuLeuven campus Gasthuisberg and is Full Professor at the faculty of Medicine of the Katholieke Universiteit Leuven.
Within his research field of anxiety and depression, expertise topics include compliance with antidepressants, antidepressant scales, methodology in trials, conceptualisation of depression and anxiety, quality of life, and epidemiology. He is a principal investigator in the European Study on the Epidemiology of Mental Disorders (ESEMED) and serves as a Member of Advisory Board at Jeevan Scientific Technology Limited. Prof Demyttenaere is author or co-author of more than 200 international papers and book chapters.
The lack of positive affect and anhedonia is probably the most specific depressive symptom, and secondly, (by) influencing somatic health (is very powerful as a predictor), protects against suicide.
We all know that with the available pharmaceutical, pharmacotherapeutic, pharmacological, or psychotherapeutic methods we are much stronger in reducing the negative than increasing the positive in depressed patients.
Prof Demyttenaere begins this section of his presentation with a discussion of suicidality and the known moderate-to-poor correlation with severity of depression. He reintroduces the concept of how the lack of positive affect is seemingly very important in the protection against suicide with data from several new studies.
He discusses the findings of these studies performed with adolescents and adults and the relevance of positive affect 2 months after discharge from hospital.
Discussing the symptoms of major depression, Prof Demyttenaere presents the relationship between pharmaceuticals and the different areas of psychiatric interest such as anxiety, anhedonia, and cognitive symptoms.
Which symptoms cluster well together in depression?
The cluster most predictive for a positive or negative outcome was the one in red (Interest-activity). They reflect positive affect and cognition which cluster well together.
Cognitive function is more closely related to positive affect than negative affect, and this is associated with the SCAR hypothesis that postulates that patients in remission have a cognitive scar that increases with the number of previous episodes of severe depression.
The SCAR hypothesis was tested in a study by Gorwood et al., (2015) by using the Trail Making Test A (TMT-A). The study found that the time needed to perform Trail Making Test A (TMT-A) increases with the number of past depressive episodes, both when carried out at baseline (blue boxes) and when carried out after treatment on the whole sample (red boxes) and when limited to patients in remission.
Concluding this video excerpt, he demonstrates the difference between depressed and non-depressed individuals using a face and emotion recognition experiment.
If one is depressed, there is a selective attention to sad or neutral faces. Even when in remission the selective bias persists albeit lower.
The findings suggest that clinical recovery in unmedicated MDD individuals is associated with enduring, trait-like abnormalities in the left OFC and DLPFC in the context of processing negative emotional stimuli. Further, the right DLPFC may mediate a compensatory response during recovery.
The findings support deficits in left OFC and DLPFC responses to negative emotional stimuli during euthymic periods of MDD, which may reflect trait markers of the illness or a ‘scar’ due to previous depression.
Take Home Messages
- Positive affect is highly protective against suicide and a statistically significant factor in recent studies of adolescents
- Face and emotion recognition experiments reveal how depressed patients spend longer looking at sad and neutral expressions
- Patients in full remission after depression retain a cognitive scar in line with the severity of their depression
- Yen S, Weinstock LM, Andover MS, Sheets ES, Selby EA, Spirito A. Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up. Psychological medicine. 2013;43(5):983-993.
- Uher R, Perlis RH, Henigsberg N, et al. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychological medicine. 2012;42(5):967-980.